Impact on IVF outcome following Pre-IVF hysteroscopy and endometrial scratching

Abstract

Background: Transvaginal ultrasonography and hysteroscopy are the tools to assess the inner architecture of the uterus.In India as such very few studies were conducted to see the effect of endometrial injury on the pregnancy outcome, so the current study was conducted to assess the efficacy of hysteroscopy in identifying the uterine pathologies and to assess the pregnancy rate following the endometrial scratching. Methods: A prospective cohort study was conducted during June 2012 to may 2015 at KJK Hospital, Trivandrum. All patients undergoing IVF in the said duration are scheduled for Pre IVF Hysteroscopy prior to the onset of periods. All the study population had undergone a transvaginal USG and hysteroscopy. Half of the study population (n=175) had underwent endometrial scratching and the occurrence of clinical pregnancy was compared among the group who had not undergone the endometrial scratching. Results: The sensitivity (100%) and specificity (85%) was much higher for hysteroscopy when compared with USG. There was a statistically significant difference in the occurrence of clinical pregnancy among the patients for whom endometrial scratching done when compared to those who had not undergone endometrial scratching (p<.0001). Conclusions: Through hysteroscopy, the intrauterine pathologies and structural uterine abnormalities that may be responsible for the failure of IVF can be detected and treated, resulting in improved pregnancy rates and the clinical pregnancy and implantation rates significantly increase after endometrial scratching in same cycle in patients with good-quality embryos.

Endometrial scratching during hysteroscopy in women undergoing in vitro fertilization: a systematic review and meta-analysis

“…Additionally, the fact that ES during hysteroscopy can be performed as an easy additional procedure, renders it a cost-effective and appealing method for augmenting the chances of a successful IVF. Notably, despite common worries about the possibility of adverse effects of interventional techniques, the current literature does not raise worries and our results showed no statistically significant impact on miscarriage rates ( 3 , 29 ).…”

“…Hysteroscopy has been rapidly spread in in vitro fertilization (IVF) as it seems to improve the chances of clinical pregnancy or live birth (1). Many reproductive medicine specialists recommend hysteroscopy as an accurate tool compared to the high falsepositive and false-negative rates in detecting intrauterine abnormalities with hysterosalpingography (HSG) (2)(3)(4). Nevertheless, World Health Organization (WHO) recommends office hysteroscopy only in cases where an intrauterine abnormality is suspected by other clinical or complementary diagnostic exams (3).…”

“…Combining hysteroscopy with ES seems to be a new trend in IVF as many authors have published trials with favorable results after this manipulation (3,(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). However, a reported significant variation exists in the patient population (unselected, one or more IVF failures), scratching technique (plastic biopsy catheter, Novak curette, hysteroscopic scissors, claw forceps, or the scope itself) and the timing of the scratching [early or late follicular phase before embryotransfer (ET)].…”